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Reproductive Health Research

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Adolescents have unique reproductive and sexual health needs. Some of the challenges faced by adolescents include early pregnancy and parenthood, difficulties accessing contraception, and high rates of sexually transmitted infections. Reproductive health research at CPCE seeks to identify optimal ways of delivering sexual and reproductive health care services to adolescents and their families with the goal of increasing the utilization of preventative health services.

Adolescent Reproductive Health

Adolescent reproductive health research at CPCE focuses on increasing adolescent utilization of preventive health services, such as HPV vaccination, annual gynecology assessments, STI screening, and contraception services, as well as developing innovative interventions for clinical care settings to meet this priority.

Through this work, we aim to reduce teen pregnancy, STI transmission, and other risky sexual behaviors by promoting healthy reproductive health behaviors. We conduct secondary analyses of large, national datasets and health system-based electronic medical records; randomized trials of clinical and behavioral interventions, qualitative (interview and focus group) studies; and analyze the impact of insurance policies on clinical care.

Highlights of this line of research include:

A recent paper that was accepted for publication by Perspectives on Sexual and Reproductive Health found that females who perceived themselves to be overweight were more likely to engage in risky sexual behaviors.

An ongoing study has found that insurance companies in the Philadelphia marketplace are not in compliance with the Affordability Care Act’s (ACA) mandate to cover contraceptive services without copays which is limiting adolescent access to contraceptive services.

Preliminary results from a recent clinical trial demonstrates that adolescent women ages 14 to 22 years report lower levels of pain at the time of insertion of a contraceptive intrauterine device when given a paracervical nerve block compared to those randomized to receive a sham (no-medication) block. Preliminary results from this recent clinical trial also show that compared to older adolescents (ages 18 to 22 years) those who are younger (under age 18 years) are more likely to present with complaints of common side effects for which they were counseled about prior to initiating their contraceptive method.

What's Next?

Team members are actively working on the following projects:

Study of Pain Control with Paracervical Block and Insertion of Skyla IUD (SOPHI Study) – A multisite study examining the effect of paracervical nerve blocks on pain during IUD insertion adolescent women.

Adolescent IUD Experiences in First Year of Use – Exploring factors influencing IUD uptake and experiences during the first year of use among adolescent women.

Role of Romantic Relationships in the Sexual Behavior of Obese and Non-Obese Girls – Examining the effect of peer and intimate relationships on obese and non-obese girls’ sexual behaviors.

Teenage Pregnancy Prevention Program – Developing and testing an adolescent-centered model of contraceptive care to reduce teen pregnancy, including an Initial Reproductive Health Visit (IRHV) for adolescents aged 12 to 19 years, a health coaching program to support contraceptive adherence, and a youth and parent peer contraceptive advisor program.

Funding: Bayer Healthcare Pharmaceuticals, Inc.; National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development; U.S. Department of Health and Human Services, Office of Adolescent Health; The Society of Family Planning; The University of Pennsylvania Center for Public Health Initiatives

Please contact Jennifer Harding, MPA, Administrative Director of Research at the Center for Pediatric Clinical Effectiveness (CPCE) and PolicyLab and the Division of Adolescent Medicine, for more information about this line of research.

Improving Access to Contraception

Unintended pregnancies, a measure that includes both unwanted and mistimed pregnancies, account for 73% of teen pregnancies in Pennsylvania. Almost 20% of teen births occur to teens who are already mothers. These repeat teen births have higher rates of low birth weight and prematurity than first teen births, and mothers with repeat teen births have lower educational attainment and higher rates of poverty as adults.

Long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include injections, intrauterine devices (IUDs) and subdermal contraceptive implants. Access to LARC decreases rates of unintended pregnancy.

CPCE’s reproductive health researchers are working to leverage infant well visits to identify teen mothers with unmet contraceptive needs in order to connect them with LARC-providing clinicians. Postpartum women frequently receive care in multiple settings as they seek care for themselves and their infants. While many women never complete a postpartum visit with their physician, the majority of new mothers report a visit with a pediatric clinicians in the weeks following delivery. Pediatric clinicians are therefore well positioned to improve LARC access for mothers.